Anemia results from a number of underlying causes.

Anemia can be defined as a

reduction in red blood cell mass or blood haemoglobin concentration. This is accomplished by
using hemoglobin (Hb), a tetramer protein composed of heme and globin. In anemia, a
decrease in the number of RBCs transporting oxygen and carbon dioxide impairs the body’s
ability for gas exchange. The decrease may result from blood loss, increased destruction of
RBCs (hemolysis), or decreased production of RBCs (Paula, 2015). Anemia in this patients can
cause multifactorial etiology, it can due to chronic disease like congenital heart disease and
nutritional deficiency. Patients has no corrected the anemia, because haemoglobin level was
10, we just observation the patient condition.

Children with congenital heart disease commonly experience delayed growth. Because
growth and development are closely related, both should beconsidered when a child’s progress
is examined.To evaluate the growth and development in young children, especially those with
congenital diseases, it is necessary to identify developmental delays and provide access to
early intervention (Chou et al., 2008). Specifically, even if the weight of a child with CHD is
normal at birth, their weight-to-height ratio decreases rapidly as they get older; this decrease is
particularly true for patients with cyanotic heart disease (Alderman, 2000). Developmental
milestones, including sitting, crawling, standing and walking, may be delayed (O’Brien & Smith,
2014). Results for gross motor development delay were consistent with those reported by
Loeffel (2008) and O’Brien and Smith (2014), gross motor development was significantly slower
in the children with CHD, children with CHD experience delayed growth because of possible
genetic influences, tissue hypoxia, reduced cardiac output, pulmonary hypertension, repeated
respiratory tract infections and malnutrition (Wu et al., 2008). In this case there will be a risk of
delay in gross and fine motor development, this will possible because there is an underlaying
aetiology of congenital heart disease with its complications, which may causing dysfunction of
central nervous system and musculoskeletal due to genetic influences, tissue hypoxia, reduced
cardiac output, pulmonary hypertension, repeated respiratory tract infections and malnutrition.

The counseling role of psychological and psychosocial support that can be done by
caregivers directly or indirectly involved in patient’s care is enormous. This support has a
strategic and important meaning in the effort to improve the quality and extend the life
expectancy of the patient. This is important because psychosocial support will affect physical
behavior and appearance, including individual body resilience (Areias et al., 2013). In this
patients counseling the patient's parents about the condition of the patient's illness, the
possibility of living as normally as possible, the importance of adherence to long-term treatment,
the worst possibility that can occur as a result of illness or long-term treatment, prognosis and
the importance of psychosocial support has been pursued through family and health personnel
who took care of her.

Passive immunization is a passive transfer of antibodies. Vaccination is an active

immunization by administering a vaccine (antigen) that can stimulate the immunity (antibodies)
by the immune system in the body. An effective vaccine must be able to stimulate all
components of the immune system because the protective immune response is largely
determined by the large role of the non-specific immune response (Ranuh et al., 2017).
Immunization recommendations for children are also made by IDAI to protect children from
various diseases. This recommendation is made along with the recommended time and catch
up immunizations for children who were not previously immunized (IDAI, 2017). In this case, this
patient was last immunized at 3 months old, polio 1 and dpt 1. so it is necessary to catch
immunizations to the patient according to Indonesia Pediatric Society recommendations.
Monitoring should be carried out routinely on the patient and it is important to educate the
patient's parents about the importance of immunization in the patient, and an explanation that
the patient's illness is not a contraindication to immunization. Catch up is given routinely with a
minimum interval of giving every 4 weeks